There have been only limited studies in humans and only rare anecdotal evidence of St. John's wort's effects on reproduction and lactation. A study using hamster oocytes incubated in either 0.06 or 0.6 mg/mL of hypericum extract for 1 hour showed normal sperm penetration at the lower concentration, whereas no penetration occurred at the higher concentration. Sperm incubated in the same concentrations for 1 week demonstrated sperm DNA

denaturation and decreased viability with both concentrations. None of these effects have been seen in vivo. In vitro testing using animal uterine tissue showed weak uterine tonus-enhancing activity, but there have been no reports of abortions in animals or humans taking St. John's wort. A study using female mice fed 180 mg/kg hypericum extract or placebo starting 2 weeks prior to pregnancy and lasting until delivery demonstrated that the birth weight of the male offspring was significantly lower in the hypericum arm compared to placebo (1.67 g vs 1.74 g), but the weights were equivalent by day 3. There was no difference in female weights. There were no differences in mice of both genders in any other areas measured, including body length, head circumference, sexual maturation, or attainment of developmental milestones

A case report involving a 38-year-old female who was in a major depressive episode began taking St. John's wort at 24 gestational weeks and continued with the therapy until delivery. The pregnancy was generally unremarkable, with a relatively mild case of late onset thrombocytopenia and neonatal jaundice that developed at day 5 and responded to treatment. The child was 7 Ibs 8 oz, had Apgar scores of 9 at 1 and 5 minutes, normal physical and laboratory results, and normal behavioral assessments at 4 and 33 days (92).

Postpartum depression is a relatively common occurrence in women after childbirth. One female who started taking 300 mg of St. John's wort (Jarsin 300) three times daily after meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major depressive episode 5 months after delivery agreed to have milk samples tested. Hypericin was not detected in the milk samples, but hyperforin was detected at low concentrations, with higher levels in the hind-milk than the foremilk samples. The milk/plasma ratio was well below one for both hypericin and hyperforin. Both levels were undetectable in the infant's serum and the baby showed no negative side effects

(93). A larger study that involved 30 women who were taking St. John's wort and breastfeeding compared results to women who were not taking St. John's wort. There were no differences in maternal events, including duration of breastfeeding, decreased lactation, or maternal demographics. Women taking St. John's wort did report a significantly higher level of infant side effects, such as lethargy and colic, vs one case of infant colic in 97 women not taking St. John's wort. None of these infants required medical attention (94).

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